What does the future hold?

The National Disability Insurance Scheme (NDIS) is heralding a new era in disability services as it rolls out across the country.

Past disability services have been described as a patchwork of supports, beholden to government budgetary cycles, and delivering more to those who scream the loudest. But now the NDIS is here it is expected that service provision will be more accessible and coordinated for more people.

The federal government says it is 100 per cent committed to the NDIS, but the federal Minster for Social Services Scott Morrison and Assistant Minister for Social Services Mitch Fifield say the NDIS faces a $7 billion shortfall. Reportedly, the government’s answer to this problem is to cut welfare spending. But whose welfare?

Will the government give the NDIS with one hand, while reducing the Disability Support Pension (DSP) with the other? Assistant Minister Fifield’s spokesperson would not be drawn on welfare cuts; instead, pointing to the recent introduction of government appointed doctors to assess new DSP claims, compulsory participation activities for people aged under 35 who can work for more than eight hours per week, and Minister Morrison’s desire for a sustainable welfare system.

The recently elected Spinal Cord Injuries Australia (SCIA) President Joan Hume is unimpressed with the government’s response. “Without the full roll out of the NDIS, the cost estimates of the scheme are merely that: estimates … Given the Abbott government’s failure to sell its last budget to the Senate and the community, it is very easy to scapegoat a vulnerable target: people with disabilities,” she says. “It was always my understanding that the NDIS was to be funded in part by the Medicare levy of an assured annual $3 billion, that the scheme would generate a $32 billion increase in GDP and would create 220,000 jobs.”

Despite the budget debate, the NDIS rollout in trial sites continues. The National Disability Insurance Agency (NDIA) points out that the scheme cannot be all things to all people, but it will provide “reasonable and necessary supports” so people with disability can live an “ordinary life”.

Meeting expectations
Following a recent citizen’s jury that examined evidence from NDIS participants about the scheme’s effectiveness and which was run by People with Disability Australia (PWDA), a report is due to be released at the end of April. Also, the federal government is developing a framework to ensure NDIS services are safe and effective.

Meanwhile, the February 2015 NDIA sustainability report says many participants are pleased with the scheme: 73 per cent rating their experience as “very good” and 22 per cent rating their experience as “good”. Also, 11,000 plus participants have had plans approved.

At the grassroots level, Simone Stevens told the Federal Parliament Joint Standing Committee on the NDIS last year that the scheme had transformed her life. “… I was getting 21.1 hours before, and now I am getting 42 hours. I am doing a lot more. I can be more flexible,” she said. As examples, she told the committee that the NDIS funding enabled her to work in Melbourne and visit a friend she had not seen in 19 years.

Amanda Samek also welcomed the NDIS. “I had a few hiccups at the start but patience and perseverance sorted them out,” she told the Joint Standing Committee last year. “… I could not get in or out [of bed] … so [the NDIS planner] ordered [a new] bed. I have now got a bed that lifts me up and down.” The planner also arranged for decking, so she could get into the backyard. “I feel normal when I have got visitors because I can … go out in the backyard with them,” she said.

Tabi Senda’s initial experience with the NDIS has also been positive. She has been able to hire two support workers to help her achieve goals important to her; for example, rearranging her bedroom, facilitating her participation as a non-skating roller derby official (learning to do the scoring) and supporting her on campus at university – when she is able to attend.

However, Tabi’s mother, Naomi Anderson, points to frustrations with the NDIS, such as delays in waiting for basic items, such as adjustments to Tabi’s existing hoist, a single point walking stick and the correct ankle and foot orthoses.

She has also experienced difficulties at the NDIS and Health Department interface. As Tabi is susceptible to fractures, before entering the NDIS she had been receiving ongoing physiotherapy and gym work under her Victorian Individual Service Plan, to help maintain her function. But since entering the NDIS she has been told that the NDIA will only provide 10 physiotherapy sessions and she will need to seek ongoing services via the Victorian Health Department. But Naomi says the Health Department does not provide the services Tabi needs, and she is now trying to resolve the issue via the NDIA. Tabi’s disability is permanent; she needs the ongoing physical intervention, Naomi adds.

Speaking about mainstream services generally, the Assistant Minister’s spokesperson says that, where appropriate, NDIA planners should be supporting participants to access mainstream services. Nevertheless, COAG is considering the experience of the trial sites to determine whether lessons can be learned, the spokesperson adds.

At the other end of the spectrum, however, others would like the NDIA to limit the provision of supports. “I don’t believe it should fund decking, iPads, sporting fees, etc. These are items that should be saved up to purchase just like the rest of us do,” says correspondence to the Joint Standing Committee.

Assistant Minister Fifield’s spokesperson disagrees, saying a person’s circumstances are unique and relatively modest investments in technology can often have a significant impact on a person’s independence and participation.

SCIA CEO Peter Perry agrees: “From both an equity and financial point of view, such things as iPads and gym memberships, when assessed [as reasonable and relevant] should be provided, as these will assist people towards greater selfefficacy and less reliance on welfare and other social support systems.”

Personal care
For a number of people with spinal cord injury, one of the most significant services provided under the NDIS is personal care. At the moment, care agencies can charge $36.70 per hour for this service. Is this enough?

“Anecdotally, it is insufficient and must change. If it doesn’t, organisations will withdraw from the market, and this will lead to either a shortage of services, or a race to the bottom in terms of quality,” says Peter.

Joan agrees: “…The quoted fee appears not to be flexible enough to cater for those who need daily care including weekends and public holidays. The pay rates vary according to day, evening overnight, and weekend charges.”

Nevertheless the Assistant Minister’s spokesperson remains confident about the price, saying “When the market matures, it is the intention that prices be deregulated and no longer set by the Agency at a time when the market is mature enough to ensure supply”.

The NDIS is set to be a life-changing service for many people. Let us hope that as time rolls on it lives up to its expectations.